Message from the Chief of Staff

Medical Staff members who have followed the recent legislative session in Hartford must have many questions concerning where matters stand, particularly the content of Senate Bill 35 which concerns acquisition of practices and conversion of not-for-profit to for-profit hospitals. Yale-New Haven Hospital was in close communication with lawmakers over the last month because the recently-announced partnership with Tenet depended greatly on the legislative outcome.

Connecticut law has never proscribed the non-profit hospital transfer to a for-profit. Sharon Hospital, a 78-bed general medical and surgical hospital in Connecticut's northwest corner, was purchased by Nashville-based Essent Healthcare in 2002, received an infusion of $40 million in capital, and shortly thereafter developed a positive balance sheet. However, the negative changes in the fiscal health of some not-for-profit Connecticut hospitals in the last five years prompted several hospitals to seek a relationship with for-profit Tenet Corporation and, as a result, the legislature considered what legal changes needed to be made if such conversions were to take place. Currently, Waterbury Hospital, Bristol Hospital, Manchester Hospital and Rockville Hospital are pursuing a relationship with Tenet. Further, YNHHS has developed a partnership agreement with Tenet to improve healthcare delivery and accept insurance risk.

A second major component of the bill related to physician practice acquisitions. While Senate Bill 35 permits for-profit hospitals and health systems to organize and become a member of a not-for-profit medical foundation, it also contains a number of provisions affecting mergers, consolidations or other affiliations of group practices that involve or create groups of two or more physicians. Effective October 1, 2014, these apply to hospitals, medical foundations and medical schools. Among other mandates, these will require annual reporting to the Connecticut Attorney General (AG) and Commissioner of Public Health, as well as the requirement that hospitals notify the AG 30 days in advance of an acquisition.

A Certificate of Need will be required for the transfer of a group practice of eight or more physicians to any entity other than a physician or group of physicians. This applies after September 1, 2014, so it will not affect the integration of the Northeast Medical Group (NEMG) with PriMed. Once the details of the legislation become clearer, we will try to keep you apprised of them and their potential impact. Join us at the July 31 Medical and House Staff Picnic

The Medical and House Staff Picnic will be held Thursday, July 31, from 4:30 to 9:30 pm, rain or shine, at Holiday Hill, 43 Candee Road in Prospect. The event will feature seafood, salads, steak, lobster, beer, wine, fruit and desserts, and numerous activities for adults and children. There is no cost for Medical and House Staff and their immediate family members. Please RSVP by July 21 (no late reservations will be accepted), including number and names of attendees and ages of children, at (203) 688-2615 or helene. williams@ynhh.org.

Performance management update

March 2013 - February 2014 CMS/TJC Core Measures Performance

AMI

#

YNHH%

Nat’l 90th%

ASA at arriv.

298/298

99

100

ASA at D/C

278/282

99

100

B-Block at D/C

258/263

98

100

Statin D/C

261/269

97

100

PCI <90

33/34

97

100

CHF

#

YNHH%

Nat’l 90th%

LVEF assess.

339/339

100

100

ACEI at D/C

70/76

92

100

D/C instr. given

178/184

97

100

Pneumonia

#

YNHH%

Nat’l 90th%

Blood Cx before Abx

133/143

93

100

Initial (ICU and non-ICU)

Selection Abx

64/65

99

100

SIP

#

YNHH%

Nat’l 90th%

Proph Abx 1 hr

383/391

98

100

Abx selection

383/388

99

100

Proph Abx D/C

363/365

99

100

DVT proph given

386/387

99

99

6 am glucose

103/116

89

100

BB Periop period

242/243

99

100

Foley removal POD2

398/408

98

100

To successfully meet the demands of the changing healthcare environment, we must sustainably eliminate costs from patient care delivery while improving the quality of care. YNHHS's clinical redesign initiative involves a systematic and comprehensive approach to improving the value of care delivery and measurably improving quality while aiming to reduce expenses by more than $60 million a year.

YNHH accomplishes clinical redesign through a combination of leadership line of sight, central governance, engaged clinician and project management resources, and innovative analytics and decision support. The initiative is structured around clinical services, with close partnerships and mutual accountability between nursing, physician and administrative leadership.

There are currently over 50 clinical redesign projects underway, with key improvements to date in medicine, cardiology, orthopedics, surgery, oncology, laboratory medicine and children's services.

A significant driver of clinical redesign is collaboration between clinical teams, finance, analytics and decision support to identify redesign opportunities and track and measure project results. Clinical redesign implementation is supported by the Epic EMR and drives the adoption of best practices across system providers.

In addition, clinical redesign's partnership between clinical and analytics leaders has created a robust measure of Quality Variation Indicators (QVIs), or a ranked series of adverse hospital events or conditions that are not present on admission. QVI-related analyses capture the frequency and cost of complications in care delivery and allow clinical redesign teams that reduce the incidence of QVIs, such as procedure complications and infections, to accurately identify how their efforts have improved outcomes while decreasing the costs of care.

Clinical redesign initiatives currently underway include standardization and improvement in ICU care, appropriately increased palliative care consults, reduced complications and improved LOS across a series of patient populations, advanced sepsis patient care, optimized lab and radiology utilization and effective management of patients in cardiac and orthopedic care bundles. Clinical redesign also drives integration with other high-value initiatives across the health system, such as a bundled payment pilot program, high reliability organization implementation, value-based purchasing, Epic point of order price transparency, and a system-wide communication plan designed to engage front line clinicians in improving care efficiency. If you would like to learn more about clinical redesign or have an idea for a clinical redesign project, please contact the initiative's sponsors, Tom Balcezak, MD (thomas.balcezak@ynhh.org), or Alan Kliger, MD (alan.kliger@ynhh.org).

SRC Clinicians' Study Center

The new Clinicians' Study Center opened in room E113 on the first floor of the Orchard Medical Building at the Saint Raphael Campus on June 2. The hours will be Monday through Friday from 7 am — 7 pm. This valuable resource for clinicians was designed to provide a dedicated quiet place for study, reading or computer use. The center is equipped with 10 state of the art computers, a printer and seating for approximately 25 people. Four Yale University librarians will rotate hours to assist with log-on and navigation of the Yale School of Medicine Library. The study center has been made available to attending physicians, residents, nurses, PAs and students; entry is via badge access. If you are unable to enter, please contact Patti Verni in the Chief of Staff 's Office at (203) 789-6297.

Upgrade to PAC system

Information Technology Systems (ITS) upgraded the Fuji PACS (Picture Archiving and Communication System) to version 4.2 of the Synapse application on May 31, 2014. Fuji PACS now offers enhanced comparison features, new edge enhancement presets for radiography images, and compatibility with a 32 or 64 bit operating system, Windows 7, and IE 8 or IE 9. User IDs and passwords will remain the same and functionality within the application does not change.

In addition, the Yale Health Center PACS system (also Fuji Synapse) was consolidated with the Yale New Haven Health System Synapse. For clinicians, this means that images from Bridgeport and Yale-New Haven hospitals, the Yale Health Center and all outpatient imaging centers are now available in one place. Clinicians can view everything from all sites by logging into YNHH PACS.

Synapse is available to all clinical users through Citrix at citrix.ynhh.org, and if you do not currently have access and wish to gain it, please contact the YNHHS Help Desk at (203) 688-4357. Please direct any further questions to DITraining@ynhh.org.

Attending Notes

John Leventhal, MD, medical director of child abuse programs and child abuse prevention programs at Yale-New Haven Children's Hospital, was honored by the Center for Children's Advocacy at its 2014 Champion of Children's Awards reception in May. With more than 30 years of experience in child abuse and neglect prevention, Dr. Leventhal has served as an expert consultant to Connecticut's child protective service agencies and is recognized nationally for his research in the area of child maltreatment. Dr. Leventhal has led efforts to bring child abuse and neglect prevention-focused programs and services to Yale School of Medicine and Yale-New Haven Children's Hospital.

Pediatric Specialty Center at Trumbull opens June 24

Yale-New Haven Children's Hospital will open a new pediatric specialty center at 5520 Park Avenue in Trumbull on June 25 to meet the growing need for pediatric specialty care in Fairfield County and offer children and adolescents specialized medical care from YNHCH pediatric subspecialists in cardiology, gastroenterology, endocrinology, respiratory, pediatric surgery and hematology/oncology. Located at the entrance of Exit 47 of the Merritt Parkway (Route 15), the 11,000 square-foot facility includes exam rooms, infusion bays, echo rooms, an isolation room, a procedure room, a blood draw room and an exercise testing/PFT room. Other YNHCH pediatric specialty centers are located in New Haven, Norwalk and Greenwich.

YNHHS Physician and Services Referral Center reminder

Please take the time to review your online profile on the Yale New Haven Health Physician and Services Referral Center site at www.ynhh.org "Find a Doctor" to ensure the accuracy of your information. If you have changes to make to your profile or demographic information, please fax the changes to (203) 688-5444 or email them to daniel.vener@ynhh.org.